Motherhood in adolescent mothers: Maternal attachment,mother–infant styles of interaction and emotion regulation at three months

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother–infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother–infant dyads compared to 30 adult mother–infant dyads. At infant 3 months, mother–infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother–infant dyads (vs. adult mother–infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother–infant dyads (vs. insecure adult mother–infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother–infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.     

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.     

Antenatal and postnatal depressive symptoms: Association with quality of mother–infant interaction

Antenatal and postnatal depression are independently associated with an increased risk of adverse infant development. A key linking mechanism is the quality of mother–infant interaction.ObjectivesThis study assesses the association between postnatal depressive symptoms (PDS) and their severity, with the quality of mother–infant interaction and compare the quality of mother–infant interaction and severity of the symptoms depending on the presence or absence of antenatal depressive symptoms (ADS).Methodsobservational study in 177 psychosocial risk mother–infant dyads from Chile (infant aged 2–12 months).ResultsMothers with PDS had lower maternal sensitivity and a more intrusive/controlling style than mothers without PDS, although the severity of the symptoms was not associated with lower maternal sensitivity. Maternal sensitivity did not differ in the postnatal depressed mothers depending on the presence of ADS, although the mothers differed in interaction style and the severity of symptoms. Mothers with ADS and PDS presented with a predominant intrusive/controlling interaction style and more severe depressive symptoms, whereas those with only PDS presented with a predominant nonresponsive/passive interaction style and reduced severity of symptoms.ConclusionsThe results corroborate the need to offer treatment and dyadic interventions to antenatal and postnatal depressive mothers and postulate that the presence of antenatal depressive symptoms may influence the subsequent mother–infant interaction style and greater severity of symptoms.     

A randomized controlled trial of mother–infant psychoanalytic treatment: II. Predictive and moderating influences of qualitative patient factors

A randomized control trial was performed on 75 dyads in Stockholm, Sweden, with infants under 1½ years. It recruited mothers who worried about the babies, themselves as mothers, and/or the mother–baby relationship. Two groups of mother–infant dyads were compared. One received only Child Health Centre care (the “CHCC” group) while the other received mother–infant psychoanalytic treatment plus CHCC (the “MIP” group). Significant treatment effects were found on mother‐reported depression, interviewer‐rated dyadic relationship qualities and externally rated maternal sensitivity, and near‐significant effects on mother‐reported stress, all in favor of MIP. The objective of this study is to investigate the predictive and moderating influences on outcomes by qualitatively assessed maternal and infant characteristics. The qualitative factors covered maternal suitability for psychoanalysis, and “ideal types” of mother and child, respectively. Outcome measures from two interviews with a 6‐month interval were depression (Edinburgh Postnatal Depression Scale (J. Cox, J. Holden, & R. Sagovsky, 1987 ), stress (Swedish Parental Stress Questionnaire (M. Östberg, B. Hagekull, & S. Wettergren, 1997 ), distress (Swedish Symptom Checklist‐90 (SCL‐90; L.R. Derogatis, 1994 ; M. Fridell, Z. Cesarec, M. Johansson, & S. Malling Thorsen, 2002 ) and infant social and emotional functioning (Ages and Stages Questionnaire: Social–Emotional (J. Squires, D. Bricker, K. Heo, & E. Twombly, 2002 ), relationship qualities (Parent–Infant Global Assessment Scale (PIR‐GAS; ZERO TO THREE, 2005), and videotaped interactions (Emotional Availability Scales, Z. Biringen, J.L. Robinson, & R.N. Emde, 1998 ). Suitability for psychoanalysis predicted outcome only on the PIR‐GAS. Two overarching maternal ideal types were created, reflecting their attitude to the psychoanalytic process: “Participators” and “Abandoned.” The Participators benefited more from MIP than they did from CHCC on maternal interactive sensitivity. A contrasting, but nonsignificant, pattern was found among the Abandoned mothers. Two ideal types of babies emerged: those “Affected” and “Unaffected” by the disturbance, respectively. Among Affected babies, dyadic relationships and sensitivity among their mothers improved significantly more from MIP than they did from CHCC. The superior effects of MIP applied especially to Participator mothers and Affected infants. For Abandoned mothers and Unaffected infants, CHCC seemed to be of equal value.     

A randomized controlled trial of mother–infant psychoanalytic treatment: I. Outcomes on self‐report questionnaires and external ratings

Mother–infant relationship disturbances occur in three domains: maternal distress, infant functional problems, and relationship difficulties. They constitute common clinical problems. In Sweden, they are usually handled by nurses as part of public Child Health Centre care. Severe cases are referred to child psychiatry services. This randomized controlled trial compared two groups of mother–infant dyads in a Stockholm sample. One received only Child Health Centre care (the “CHCC” group) while the other received mother–infant psychoanalytic treatment plus CHCC (the “MIP” group). Eighty dyads of mothers and infants under 1½ years of age where the mothers had serious concerns about themselves in their role as mothers, their infants' well‐being, or the mother–baby relationship were randomly selected for either the MIP or the CHCC group. The primary outcomes were mother‐reported depression, mother‐reported infant functional problems, and interviewer‐based relationship assessments, all at 6 months after joining the project. Secondary outcomes were mother‐reported stress and general psychic distress, externally rated video‐recorded interactions, and the consumption of healthcare at the CHC, again all after 6 months. Intent‐to‐treat analyses of Treatment × Time effects significantly favored MIP treatment for maternal depression, mother–infant relationships, and maternal sensitivity. Effects were nearly significant on maternal stress, but nonsignificant on mother‐reported infant functional problems, general psychic distress, maternal interactive structuring and nonintrusiveness, infant responsiveness and involvement, and healthcare consumption. MIP treatment improved mother–infant relationships and maternal sensitivity and depression, all of which are known to influence child development. If effects persist and are reproduced, MIP treatment holds promise for more widespread use.     

Expressive timing and interactional synchrony between mothers and infants: cultural similarities, cultural differences, and the immigration experience

The spontaneous vocal interactions of 30 mothers and their 2- to 5-month-old infants from India, France, and the United States were analyzed using an acoustic analysis method. Similarities and differences in vocal interactional patterns were highlighted between the three groups. On the one hand, in the three cultural contexts mother–infant vocal interaction was found to be organized around hierarchical temporal intervals of the same approximate length, had the same balance between regular rhythm and variation (“expressive timing”), and manifested the same coordination between mother and infant vocalization (“interactional synchrony”). On the other hand, the three groups also revealed cultural variability. The Indian mothers had more togetherness with their babies, as indexed by less space between vocal turns and more overlap of mother and baby vocalizations. They also produced a higher ratio of nonverbal to verbal vocalizations. The spontaneous vocal interactions of a group of 30 Indian immigrant dyads were also studied. With respect to culturally variable characteristics, the vocal interaction of immigrant dyads living in the United States showed signs of change in the direction of the host culture. With respect to characteristics shared by all three nonimmigrant groups, the immigrant dyads showed lower levels of expressive timing and interactional synchrony than the nonimmigrant group as a whole.     

The importance of maternal state of mind regarding attachment and infant age at placement to foster mothers' representations of their foster infants

Previous research has found that foster mother state of mind with respect to attachment and infant age at placement into foster care influence the developing foster mother–foster child relationship (Dozier, Albus, Stovall, & Bates, 2000; Stovall & Dozier, 2000). This study extends prior research by assessing factors related to foster mothers' representations of their foster infants. Participants were 48 foster mother–foster infant dyads in two mid‐Atlantic cities. We expected that foster mothers' states of mind and infant age at placement would be associated with foster mothers' acceptance of infants, commitment to infants, and belief in their influence on infants' development. Consistent with hypotheses, foster mothers' states of mind interacted with infant age at placement in predicting foster mothers' acceptance of their babies, and the extent to which foster mothers believed they could influence their infants' development. Specifically, autonomous foster mothers of babies placed before 12 months of age were more accepting and more likely to believe they could influence their infants' development compared to autonomous foster mothers of babies placed after 12 months of age, a pattern not seen for nonautonomous foster mothers. These results converge with other findings suggesting that timing of placement in foster care, and foster mothers' states of mind, are important to the developing foster mother–child relationship. ©2002 Michigan Association for Infant Mental Health.     

Does ‘Wanting the Best’ create more stress? The link between baby sign classes and maternal anxiety

This study investigated whether gesturing classes (baby sign) affected parental frustration and stress, as advertised by many commercial products. The participants were 178 mother–infant dyads, divided into a gesture group (n=89) and a non‐gesture group (n=89), based on whether they had attended baby sign classes or not. Mothers completed a background demographics questionnaire and the Parenting Stress Index. Gesturing mothers had higher total stress scores, with higher scores on the child domain, despite having similar backgrounds to non‐gesturing mothers. There was no relationship between the frequency or duration of gesture use and stress scores. It is suggested that gesturing mothers had higher pre‐existing stress and were attracted to gesture classes because of the promoted benefits, which include stress reduction, although class attendance did not alleviate their stress. The possibility that attending gesturing classes made mothers view their infant in a more negative way, due to their heightened expectations not being met, is also discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

SHALL WE DANCE? MUSIC AS A PORT OF ENTRANCE TO MATERNAL–INFANT INTERSUBJECTIVITY IN A CONTEXT OF POSTNATAL DEPRESSION

The present study introduces the concept of a mother–infant group therapy that makes use of music, singing, and moving to establish maternal–infant intersubjectivity. It was conducted in a residential mother–baby unit for mothers with postnatal depression and their infants over a 5‐week period. Maternal–infant intersubjectivity of four dyads in relation to the group dynamics were microanalyzed for Sessions 1 and 5. We made within‐session (i.e., beginning–middle–end) and between‐session (Session 1 vs. Session 5) comparisons for the number of intersubjectivity moments (ISMs), total time of intersubjectivity (IST), and the mean duration of ISMs on a dyadic (i.e., own mother/infant involved) and a nondyadic level (i.e., own mother/infant not involved). In addition, three ISM levels (degree of group contribution) were distinguished. The results indicated a significant increase of ISMs/IST from Session 1 to Session 5. Within‐session analyses showed that ISMs/IST significantly decreased through Session 1 and remained stable throughout Session 5. Intersubjectivity occurred mainly on ISM Level 1 during Session 1 and on ISM Level 3 during Session 5, suggesting increased dyadic autonomy and self‐efficacy. The results are discussed in relation to the musical characteristics of mother–infant dyads, music improvisation techniques, group processes, and intersubjective development.     

Head start is too late: integrating and applying infant observation studies, and attachment, trauma, and neurobiological research to groups with pregnant and new mothers

In this paper new knowledge generated from theoretical and empirical work in infant observation studies and attachment, trauma, and neurobiology research is integrated and applied to the development of a group for pregnant and new mothers. The purposes of this group were to (1) promote the establishment of a secure base for each baby through optimum self and dyadic affect regulation, the repair of ruptures, and the emergence of positive heightened affective moments; (2) to facilitate secure attachment between mother and infant by helping mothers mentalize the experiences of their babies; (3) to build affiliative bonds between group members and; at the very least, (4) to prevent insecure disorganized attachments. The group interactions also were thought to prevent new psychopathology from developing, as well as to minimize the intergenerational transmission of trauma. A discussion of how this group came out of gestation and birthed itself in a community setting is included.     

Bed-sharing, breastfeeding and maternal moods in Barbados

Bed-sharing among Barbadian mothers and infants was studied in relationship to maternal and infant characteristics. This prospective study followed 226 healthy, well-nourished mother–infant dyads at birth, 7 weeks, 3 months, and 6 months postpartum. At each age, approximately half of the infants shared the same beds as their mothers. Bed-sharing was associated with demographic characteristics, especially fewer home conveniences, and also maternal characteristics, including less information seeking by the mother and younger maternal age at first pregnancy. Bed-sharing was also associated with lower infant birth weights. Maternal moods were significantly correlated with bed-sharing, such that mothers who reported having more despair and anxiety were also more likely to sleep with their infants. Bed-sharing was also significantly associated with increased breastfeeding at all infant ages, but this relationship was no longer significant once the effects of maternal moods were controlled. This study emphasizes the importance of assessing maternal moods in studies evaluating the risk and benefits of bed-sharing.     

The role of oxytocin in early mother-infant interactions: Variations in maternal affect attunement

The aim of the present research was to investigate the relationship between oxytocin and maternal affect attunement, as well as the role of affect attunement in the relationship between oxytocin and infant social engagement during early mother-infant interactions. Forty-three mother-infant dyads participated in the present study when infants were 4 months. They were observed during (1) a situation where no communication took place and (2) a natural interaction between mother and infant. During this procedure, three saliva samples from mothers and their infants were collected to determine their levels of oxytocin at different time points. Maternal affect attunement (maintaining attention, warm sensitivity) and infant interactive behaviors (gaze, positive, and negative affect) were coded during the natural interaction. Results indicated that overall maternal oxytocin functioning was negatively related to her warm sensitivity, while infant oxytocin reactivity together with maternal affect attunement were associated with infant positive social engagement with their mothers. Specifically, infant oxytocin reactivity was significantly related to their gazes at mother, but only for infants of highly attuned mothers. These results point to the complex role oxytocin plays in parent-infant interactions while emphasizing the need to analyze both overall oxytocin functioning as well as reactivity as different indices of human affiliative behavior.     

Maternal depression and dyadic interaction: the role of maternal attachment style

Maternal mental health and the contents of her representational world are important determinants of early parent–child relationship. We examined, first, the role of prenatal and postnatal depressive symptoms and maternal attachment style in predicting the quality of mother–child interaction. Second, we analysed whether the secure‐autonomous attachment style can protect the dyadic interaction from the negative effects of maternal depression. The participants were 59 mother–infant pairs examined during pregnancy (T1), 4–5 months postpartum (T2) and when the children were approximately 14 months old (T3). Maternal attachment style was assessed with a modified Adult Attachment Interview ‐procedure, depressive symptoms with Edinburgh Postnatal Depression Scale, and observed mother–child interaction with Care Index. The results show that autonomous mothers were more sensitive and responsive and their children more co‐operative than dyads with dismissing maternal attachment style. As hypothesized, mothers with the combination of both prenatal and postpartum depressive symptoms were highly unresponsive in their dyadic interaction. Further, prenatal depressive symptoms had a stronger impact on maternal unresponsiveness than postnatal symptoms. As hypothesized, mother's autonomous attachment style protected the mother–child interaction from the negative impact of maternal postnatal depressive symptoms, whereas dyads with preoccupied mothers were especially at risk for interaction problems when mothers had postpartum depressive symptoms. Copyright © 2010 John Wiley & Sons, Ltd.     

Association between Hyperemesis Gravidarum in pregnancy on postnatal ability of infants to attend to a play task with their mother

Research indicates a higher prevalence of attention deficits in children exposed to HG in utero compared to controls with some claiming that the deficit is due to prenatal effects of malnutrition in HG mothers and others that it is due to maternal mental health after birth. The current study examines the effect of hyperemesis gravidarum (HG) diagnosis during pregnancy on infant attention controlling for maternal stress, depression anxiety and attachment. Thirty-eight infants mean age 4 months were videotaped with their mothers (19 mothers with a hyperemesis diagnosis and 19 controls) during play with a soft toy and looking at a picture book. Infant attention was operationalized as gaze direction towards the play activity, mother, and ‘distracted’ (indicated by looking away from play or mother). Mothers completed stress, depression, anxiety, and attachment questionnaires. HG exposed infants attended for significantly less time during play with a book or soft toy compared to controls. Maternal stress, depression, anxiety, and attachment did not differ in HG mothers and controls. Infant ability to attend to the toy, book, mother or being distracted did not relate to maternal postnatal attachment, or mental health. These results suggest that the prenatal environment, especially exposure to HG might be associated with reduced infant attention abilities independent of maternal postnatal health.     

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug‐abusing mothers

The purpose of this controlled study was to examine the outcome of psychodynamic mother–infant group psychotherapy (PGT) outpatient intervention for drug‐abusing perinatal mother–infant dyads. PGT comprised 20 to 24 weekly 3‐hr sessions with 3 to 5 months of follow‐up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother–infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother–infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug‐abusing dyads in PGT, 25 in PSS, and 50 dyads in a non‐drug‐abusing comparison group. Assessments were pre‐intervention and at 4 and 12 months' follow‐up, including maternal depressive symptoms and mother–child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother–infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high‐risk dyads.     

Kangaroo mother care and mother‐premature infant dyadic interaction

The aim of this study was to investigate the psychological impact of Kangaroo Mother Care (KMC) on mother‐infant bonding in cases of premature delivery. Examined variables were mother‐infant relationships, maternal anxiety levels, and infant interactive signals. The KMC method requires that babies be undressed and held upright between their mother's breasts for a minimum of 1 hr a day, from birth until they are discharged from hospital. The present study examined 40 premature infants and their mothers, with 21 dyads experiencing KMC and 19 receiving traditional care (TC). Maternal emotional stress was assessed with the Parent Stress Index‐Short Form questionnaire (Abidin, 1990), and mother‐newborn interactive style was assessed with the Nursing Child Assessment Feeding Scale (Barnard, 1975). Results revealed a better mother‐infant interactive style, a significant decrease in maternal emotional stress, and better infant ability to make requests and respond to parental interactive style in the KMC group.     

Responsiveness in mother-infant social interactions among immigrant and nonmigrant families: Japanese,South Korean,South American,and European American

A culture learning perspective motivated the present study of the acculturation of responsiveness in mother-infant interactions. Several conceptual and analytic features of responsiveness in mother-infant social interactions were examined: Temporal contingency, mean differences in responsiveness among and within dyads, attunement of mother and infant responsiveness withing dyads, and the influence of acculturation on individual responsiveness. Methodologically, acculturation was assessed at group and individual levels in immigrant Japanese, South Korean, and South American dyads in comparison with nonmigrant dyads in their respective cultures of origin (Japan, South Korea, and South America) and their single common culture of destination (United States). In total, 408 mothers and their 5½-month-old infants were observed in the naturalistic setting of the home, and observations were coded for mothers’ speech to infant, social play, and encouraging her infant to look at her, and infants’ looking at mother and nondistress vocalizations. Odds ratios were then generated for mother and infant responsiveness in four types of social interactions: Mother speaks to infant and infant looks at mother (Mother Speak/Infant Attend), mother plays with infant and infant looks at mother (Mother Play/Infant Attend), mother plays with infant and infant vocalizes (Mother Play/Infant Vocalize), and mother encourages infant to look at her and infant vocalizes (Mother Encourage/Infant Vocalize). Five key findings emerged. Specifically, mother and infant responsiveness in Mother Speak/Infant Attend interactions were temporally contingent in all cultures. Mean differences in responsiveness among cultures emerged, and within dyads infants were more responsive than their mothers in Mother Speak/Infant Attend interactions. Mother and infant responsiveness in Mother Speak/Infant Attend interactions were attuned in all cultures. Responsiveness in Mother Play/Infant Vocalize interactions showed acculturation effects at the individual level. Implications of these findings for understanding the development of responsiveness in social interactions and acculturation in immigrant families are discussed.     

Vocal responsiveness of preterm infants to maternal infant-directed speaking and singing during skin-to-skin contact (Kangaroo Care) in the NICU

Vocalizations of full-term newborns occur in a short latency time during the neonatal period. Contingent response time of preterm babies is still unknown. An increase of preterm babies’ vocalizations following exposure to parental speech was also observed. Mothers and babies co-modulate their vocalizations in preterm dyads. Purpose: To observe temporal features of maternal and infants’ vocalizations in speaking and singing conditions in preterm dyads. Methods: In a NICU mothers (N = 36) were invited to speak and to sing to their preterm infants during Kangaroo Care. Microanalysis of temporal units were performed with ELAN Software. Results and conclusions: Preterm infants vocalize less often while their mothers speak and sing than during baseline and their vocalizations tend to be more alternating in the speaking condition and more overlapping in the singing condition. It is also concluded that preterm infants take more time to respond to maternal speaking than to maternal singing.     

Goodness of fit between prenatal maternal sleep and infant sleep: Associations with maternal depression and attachment security

The current study prospectively examined the ways in which goodness of fit between maternal and infant sleep contributes to maternal depressive symptoms and the mother-child relationship across the first years of life. In a sample of 173 mother-child dyads, maternal prenatal sleep, infant sleep, maternal depressive symptoms, and mother-child attachment security were assessed via self-report, actigraphy, and observational measures. Results suggested that a poor fit between mothers’ prenatal sleep and infants’ sleep at 8 months (measured by sleep diary and actigraphy) was associated with maternal depressive symptoms at 15 months. Additionally, maternal depression mediated the association between the interplay of mother and infant sleep (measured by sleep diary) and mother-child attachment security at 30 months. Findings emphasize the importance of the match between mother and infant sleep on maternal wellbeing and mother-child relationships and highlight the role of mothers’ perceptions of infant sleep.     

Patterns of mother–infant interaction from 3 to 12 months among dyads with substance abuse and psychiatric problems

The aim of this study was to investigate the development of mother–infant interaction patterns from 3 to 12 months among three groups of mother–baby pairs recruited during pregnancy: one group from residential substance abuse treatment (n = 28), a second group from psychiatric outpatient treatment (n = 22), and a third group from well-baby clinics (n = 30). The mother–infant interaction at 3 and 12 months was assessed by the Parent–Child Early Relational Assessment (PCERA), which consists of maternal, child and dyadic subscales (Clark, 2006). Linear mixed effects models were used to analyze group differences and the changes in mother–infant interaction from 3 to 12 months.At 3 months, pairwise comparisons showed that the group with psychiatric problems had significantly more difficulties in the mother–infant interaction than the two other groups. The group with substance abuse problems was not significantly different from the two other groups. At 12 months, the mother–infant pairs in the substance abuse group showed significantly more relational disturbances than the non-clinical pairs, as well as a poorer affective quality of interaction than the dyads in the group with psychiatric problems. Analysis of change from 3 to 12 months showed that difficulties in the interaction increased among the mother–baby pairs in the substance abuse group, while improvements were displayed in the two other groups. These results underline that mother–infant pairs at double risk due to maternal substance abuse and other non-optimal factors, are in need for long-term follow up in order to prevent the development of negative interactional patterns.